在擬真情境下應用客觀結構式臨床測驗評量新進護理人員急救技能之成效

The Application of Simulation in Objective Structured Clinical Examination Evaluation Effectiveness of New Nursing Staff First Aid Skills

李惠珍(Hui-Jane Lee) ； 高麗茹(Li-Ju Kao) ； 詹淑惠(Su-Hui Chan)

《台灣擬真醫學教育期刊》 3卷1期 (2016/06) Pp. 3-10

https://doi.org/10.6582/JTSSH.2016.3(1).01

摘要

目的：探討在擬真情境下應用客觀結構式臨床測驗（OSCE）評量到職滿三個月之新進護理人員在急救技能之成效。方法：本研究為前瞻性研究，採方便取樣，於2014年6月至8月進行OSCE評核準備工作，2014年9月至2016年3月以北部某醫學中心到職滿三個月之新進護理人員（N=297）為研究對象，在擬真情境下進行急救技能OSCE評量。共測試四站，分別為第一站：急救前評估及執行心肺按摩；第二站：電擊器使用及氣管內管確認和固定；第三站：急救藥物；第四站：氧氣治療。每站測試時間為14分鐘，考官以評分表及整體表現進行評分，結束後回饋1分鐘。及格標準採「邊緣群法」（borderline method）計算，總分需高於及格分數及通過三站以上才達通過標準。結果：評分表試題難易度分析0.55-0.66，顯示難易等級為容易到適中；鑑別度0.29-0.48，為尚可到非常優秀；考官一致性（Inter-rater Reliability）Kappa 為0.725；考生平均滿意度為4.1分（1-5分），評量成績總通過率62.8%。評量結果以第二站和第四站成績較低，小組成員針對成績低的項目進行檢討，擬定重新檢視急救訓練課程內容增加臨床情境，及加強演練時實際操作之正確性，另拍攝急救操作教學影片提供人員學習的教材，以提升新進護理人員急救技能。結論：透過OSCE多面向專業能力的評量，能夠更貼近臨床，故建議以OSCE作為評量方法，藉由實作的過程評量新進護理人員急救的臨床技能、態度與專業素養等紙筆測驗所無法評量的臨床能力，而評量結果更可以作為急救教學課程修定之參考。

關鍵字

擬真情境 ； 客觀結構式臨床測驗 ； 新進護理人員 ； 急救技能

並列摘要

Objective: To explore the application of simulation in objective structured clinical examination (OSCE) evaluation effectiveness of duty for three months new nursing staff first-aid skills. Methods: This prospective study using convenience sampling, carried out OSCE preparation from June to August 2014, flexed to a medical center in the Northern Taiwan for three months of new nursing staff (N=297) for the study from September 2014 to March 2016, the application of simulation in OSCE for first aid skills. Four stations setup for skill tasks. The first station: first aid assessment and performance of chest compression in resuscitation simulation; the second station: defibrillator operation and endotracheal tube nursing care; the third station: medications in emergency; the fourth station: oxygen therapy in critical patients. Each station testing time is 14 minutes, the raters were using checklist and global rating for scoring. Then raters feedback 1 minute after test finished. Using ＂borderline method＂ as rating standard, the subjects passed 3 stations skill tasks and total score was higher than minimal a passing mark, then labeled as certification achieved. Results: Difficulty index analysis result from checklist is 0.55-0.66, showing item difficulty is from easy to moderate; discrimination index analysis is 0.29-0.48, showing discrimination ability is from fair to very good; the raters consistency (Inter-rater Reliability analysis) Kappa is 0.725; candidates average satisfaction is 4.1 (score 1-5). The final total pass rate is 62.8%, based on the second and the fourth station scores is low. After this project, we prepare to revise the contents of first aid training courses, including increasing the clinical scenarios, strengthing drills for correct practice, and taking emergency resuscitation related education video to provide personnel continuously learning to improve nursing staff first aid ability. Conclusion: OSCE evaluation is a pr ofessional competence-oriented, closer to the clinical scenario. We recommended OSCE as a method of evaluation in new nursing staff first aid skills, attitude and professionalism, beyond the traditional writing test. And evaluation results of OSCE can be also served as reference of first aid teaching courses direction.

並列關鍵字

Simulation ； objective structured clinical examination ； the new nursing staff and first aid skills